Healthcare Provider Details

I. General information

NPI: 1285257360
Provider Name (Legal Business Name): YISEL MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 8TH ST W
LEHIGH ACRES FL
33971-5317
US

IV. Provider business mailing address

3203 8TH ST W
LEHIGH ACRES FL
33971-5317
US

V. Phone/Fax

Practice location:
  • Phone: 786-857-7021
  • Fax:
Mailing address:
  • Phone: 786-857-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-117117
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-23-70396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: